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Characteristics:

• The golden yellow flowers of St. John's wort form sparsely blossomed terminal cymes. The 5 sepals are ovate-lanceolate to lanceolate in shape, and very pointed. The sepals are smooth, serrate at the tip, and marked by many light and dark glands. The 5 petals and numerous stamens are fused into 3 bundles. The ovary is oval shape in shape. The fruit is a 3-valvular capsule, which is triangular and oval. The seeds are cylindrical, pointed at both ends, 1-3 mm long, either black or dark brown, and covered in small warts (Gruenwald et al. 2000).
• St. John's wort is a perennial plant generally reaching 30 to 60 cm in height, with a long-lived, branched root and rhizome that tapers towards each end. The reddish stem is erect, has 2 raised edges, and can reach as much as 100 cm in height. The oval-shaped, translucent, punctate leaves are attached directly at the base and often covered in black glands (Gruenwald et al. 2000).

Habitat:

• St. John's wort is indigenous to all of Europe, western Asia and northern Africa. It has been introduced to eastern Asia, Australia and New Zealand, and it is cultivated in Poland and Siberia (Gruenwald et al. 2000).
• St. John's wort is most commonly found in grasslands, pastures, meadows, and rangelands. It also occurs in forested areas in natural clearings, openings, or areas that have been disturbed by fire, logging, or road construction (USDA 2015).
• St. John's wort grows in well-drained, coarse-textured soils, and does not grow well under wet conditions. St. John's wort grows equally well in both acid and calcareous soils (USDA 2015).

Parts Used:

• The medicinal parts of St. John's wort include the fresh buds and flowers separated from the inflorescences, the aerial parts collected during the flowering season and dried, and the entire fresh flowering plant (Gruenwald et al. 2000).

Collection and Harvesting:

• St. John's Wort is cut at the start of the flowering season and dried quickly in bunches in order to preserve the oils and volatile contents (Gruenwald et al. 2000).
• St. John's wort should always be gathered on a sunny day, when the flowers will be dry. The flowers are at their best just as the buds begin to open. To tell if they are ready, press a bud between your fingers. If there’s a spurt of purple or deep red, the buds are ready. If not, it’s either too early or too late (Gladstar 2012)

Constituents:

• St. John's wort contains hypericin, hyperforin, pseudohypericin, procyanidins, tannins, and flavonoids (Barnes et al. 2007; Gladstar 2012).
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Actions: (Gruenwald et al. 2000)

• The main active principles of St. John's wort are the flavone and flavonol derivatives, xanthones and naphthodianthrone (hypericins).
• A mild antidepressant, sedative and anxiolytic action of the herb and its preparations has been documented in clinical studies.
• The antidepressive effect may be largely due to the ability of the herb to inhibit the reuptake of serotonin and other neurotransmitters. An hydroalcoholic extract of St. John's wort inhibits the reuptake of serotonin, norepinephrine and dopamine with similar affinities, which leads to a significant down-regulation of cortical beta- adrenoceptors and serotonin (5HT-2) receptors. This data suggested hyperforin is the active principle of the extract in biochemical models of antidepressant activity.
• Oily St. John's wort preparations demonstrate an anti-inflammatory action due to their high flavonoid content.
• The antibacterial effect of hyperforin was demonstrated in a recent study. Hyperforin inhibited the growth of gram positive bacteria, such as Streptococcus pyogenes and Streptococcus agalactiae. Hyperforin also demonstrated efficacy against penicillin-resistant Staphylococcus aureus (PRSA) and methicillin-resistant Staphylococcus aureus (MRSA).

Indications: (Gruenwald et al. 2000)

• Internally, St. John's wort is used for psychovegetative disturbances, depressive moods, anxiety and nervous unrest.
• Externally, oily St. John's wort preparations are used for the treatment and post-therapy of acute (wounds) and contused (blunt) injuries, for first-degree burns, and for inflammation of the skin.
• Unproven uses for St. John's wort:
  • The herb has been used for worm infestation, bronchitis and asthma, gallbladder disease, gastritis (also diarrhea), nocturnal enuresis, gout and rheumatism.
  • Oily St. John's wort preparations are used internally for dyspeptic complaints, and externally for the treatment of myalgia.
• St. John's wort uses in Chinese medicine:
  • In a gargle solution, the herb is used externally for tonsillitis. The herb is also administered externally as a lotion for dermatoses.

Combinations:

• St John's wort can be combined with lemon balm, borage flowers, chamomile, and lemon verbena to make a tea which helps relieve energy blocks and stress (Gladstar 2008).

Preparation and Dosage: (Gruenwald et al. 2000)

• Capsules/tablets - 300 mg of the standardized extract should be administered three times daily.
• Dried herb - 2 to 4 g should b taken 3 times daily.
• Tea - St. John's wort as a tea is the traditional method of administration, with a single dose of 2-3 g of dried herb placed in boiling water. If 2 g of dried herb is used, and the dried herb to extract ratio is 6, a usual dose of the extract would be 300 mg.
• Liquid extract 1:1 in 25% ethanol - 2 to 4 ml should be taken 3 times daily.
• Tincture: (1:10) in 45% ethanol - 2 to 4 ml should be taken 3 times a day.
• Wounds, bruising and swelling - the herb is applied topically and locally for treatment. The activity of the topical preparations is based on the hyperforin content, which is highly variable depending on the method of oil preparation. The preparation may be stable for a few weeks up to 6 months.

Contraindications:

• Simultaneous use of a MAO inhibitor: St. John's wort contains some weak monoamine oxidase inhibitor (MAOI) properties that may add to the effects of other MAOI drugs, therefore theoretically increasing the risk for hypertensive crisis (Gruenwald et al. 2000).
• St. John’s wort can cause photosensitivity (sensitivity to sunlight) in some individuals. If your skin becomes rashy, itchy, or red, discontinue use (Gladstar 2012).

Drug Interactions: (Gruenwald et al. 2000)

• MAOI - although there is poor documentation, concomitant administration of St. John's wort and a MAOI, such as tranylcypromine or phenelzine, may lead to increased effects and possible toxicity (hypertensive crisis).
• It is prudent to avoid concomitant use with beta-sympathomimetic amines, e.g., ma huang or pseudoephedrine.
• SSRIs - St. John's Wort taken concomitantly with an SSRI (selective serotonin reuptake inhibitor), such as fluoxetine, paroxetine, sertraline, fluvoxamine or citalopram, may lead to an increased effect and possible toxicity (e.g., "serotonin syndrome" - sweating, tremor, flushing, confusion and agitation). St. John's wort has slight serotonin reuptake properties. A case report suggests that coadministration of St. John's wort with paroxetine has resulted in a clinical syndrome resembling a sedative/hypnotic intoxication.
• Tannic acids present in St. John's wort may inhibit the absorption of iron.
• Concomitant use with other photosensitizers, such as tetracyclines, sulfonamides, thiazides, quinolones, piroxicam and others should be avoided.
• St. John's wort extract has been reported to significantly prolong narcotic-induced sleeping times and to antagonize the effects of reserpine.
• Cyclosporine - decreased serum concentrations have occurred with use of St. John's wort. Acute cellular transplant rejection in heart transplant patients due to an interaction between St. John's wort and cyclosporine has been reported. St. John's wort has been proven to induce the cytochrome P450 enzyme system, the major pathway for cyclosporine metabolism. Heart transplant rejection has been reported as soon as 3 weeks after St. John's wort is added to the drug regimen of heart transplant patients maintained on cyclosporine therapy.
• Indinavir - an open label study was conducted involving healthy volunteers that were administered 800 mg indinavir (a protease inhibitor used as a component of highly active antiretroviral therapy [HAART] to treat HIV infection and AIDS) every 8 hours along with 300 mg St. John's wort standardized to 0.3% hypericin 3 times daily. Results showed a 57% reduction in the area under the curve for the protease inhibitor and an 81% decrease of the extrapolated 8-hour indinavir trough value. The authors concluded that a reduction of this magnitude could lead to development of drug resistance and treatment failure.
• Clinicians are warned that St. John's wort may significantly affect plasma concentrations of any drug that is metabolized by the cytochrome P450 system.
• Ethinyloestradiol and desogestrel (combined oral contraceptive) - breakthrough bleeding has occurred with concomitant use of St. John's wort.
• Hypericin causes a reduction in barbiturate-induced sleeping times.
• Theophylline - St. John's wort has caused decreased theophylline levels on a patient stabilized on theophylline therapy.
• Co-administration of St. John's wort extract with digoxin resulted in a significant decrease in digoxin activity as compared to a placebo. Therefore, St. John's wort may reduce efficacy of digoxin and make a patient a nonresponder, whereas increased toxicity may be anticipated after withdrawal of the herb.
• St. John's Wort (600-900 mg/day) taken concomitantly with sertraline (50-75 mg/day) after 2 to 4 days, resulted in a presumed serotonin syndrome consisting of dizziness, nausea, vomiting, headache, epigastric pain, anxiety, confusion, and/or feelings of restlessness and irritability. Cyproheptadine was used to reverse the symptoms and after discontinuation of the herb-drug therapy, all symptoms resolved.
• Nefazadine (100 mg twice daily) and St. John's wort (300 mg three times daily) taken simutaneously resulted in nausea, vomiting and restlessness after 3 days of therapy. The symptoms improved after stopping the nefazadine and continuing with St. John's wort.

History and Origin:

• St. John's wort originated in Europe, western Asia, North Africa, and Macaronesia, and has been introduced into Australasia and North America (Allen & Hatfield 2004).

Ethnobotany:

• St. John's wort was recommended in the first century by Greek physicians as a diuretic, wound-healer, and treatment for menstrual disorders (USDA 2015).
• St. John's wort tea is used as a folk remedy for bladder ailments, depression, anxiety, nervous tension, dysentery, diarrhea, and worms. The tea is also commonly used to treat tuberculosis; as a mild sedative for disturbed sleep; and as a treatment of stomach cancer, herpes, and hemorrhoids (USDA 2015).
• The potency of St. John's wort as a folk herb in Somerset, Kent, the Isle of Man, and the Highlands has arisen from its astringency and its resulting power to staunch bleeding from scratches and more serious wounds (Allen & Hatfield 2004).
• In Britain and Ireland, St. John's wort has been widely in use for low spirits, nervousness, and as a general tonic, and in the Highlands, where the herb was allegedly used by St. Columba, applied as a pad under the armpit or in the groin, to restore the sanity of a young shepherd after long hours alone on the hillsides. This legend gave rise to the Gaelic name translating as "St. Columba's oxterful" (Allen & Hatfield 2004).
• The Cherokee used a compound decoction of St. John's wort as an abortifacient; and the leaves in an infusion to reduce diarrhea, fever, and gastrointestinal pain. They used a milky compound to rub on sores; sniffed the crushed plant for nosebleed; and the root was used in poultice for snake bite (USDA 2015).
• Iroquois used the plant as a fever medicine, and the roots to prevent sterility (USDA 2015).
• St. John's wort plays an important role in the traditional knowledge (TK) systems in Spain. In this context, the flowers are macerated in olive oil and applied externally as a treatment for wounds, burns, or chapped skin (USDA 2015).
• St. John's wort blooms early, near the summer solstice; thus it derives its common name by blooming near June 24th, the birthday of St. John the Baptist. Traditionally, during this day the plants would be hung over religious icons in the house to ward off evil. In the middle ages it was called "Fuga Daemonium" or "devil’s flight" to denote this tendency to ward off evil spirits (USDA 2015).

Growing Information: (Gladstar 2012)

• St. John's wort is a sun-loving, hardy perennial, preferring full sun and somewhat dry soil, but it’s not fussy and will do almost as well in partial shade and with some drenching. It thrives in USDA zones 3 through 9, and prefers soil with a pH of 6 to 7.
• St, John's wort is quite tall, growing to 3 or 4 feet on long, spare stalks.
• St. John's wort germinates easily from seed, although the seeds need to be stratified (treated with a winter-like chill) for best germination. Once established, it will readily self-sow.
• Although there are several other species available for gardening, wild Hypericum perforatum is the best medicinal species.

Personal Impressions and Experiences:

• St. John's wort is considered an invasive weed in British Columbia. It grows profusely in Prince Rupert, along the road edges and in any cleared and disturbed spaces. This makes wildcrafting for St. John's wort both easy and fun, and you can feel like you are helping to control an invasive species.

Historical Botanical Illustrations:

Hypericum perforatum (common St. John's wort) and Hypericum maculatum (spotted or imperforate St. John's wort) - Carl Axel Magnus Lindman (1856–1928).